Poster Session 1
Category: Medical/Surgical/Diseases/Complications
Poster Session 1
.jpg "Virali Patel, BS photo")
Virali Patel, BS
Medical Research Scholars Program Fellow
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health
Bethesda, Maryland, United States
Jessica Gleason, PhD
NICHD, NIH
Bethesda, Maryland, United States
Shan-Xuan Lim, PhD
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health
Bethesda, Maryland, United States
Zhen Chen, PhD
Senior Investigator
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health
Bethesda, Maryland, United States
Dian He, PhD
Biostatistician
The Prospective Group, Inc.
Fairfax, Virginia, United States
Jagteshwar Grewal, PhD
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health
Bethesda, Maryland, United States
Katherine L. Grantz, MD, MSCR
Senior Investigator
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health
Bethesda, Maryland, United States
Physiologic changes in the maternal cardiovascular system associated with pregnancy are more pronounced in multiple gestations compared to singletons. However, it is unknown whether these changes lead to increased morbidity during childbirth. We compared the risk of cardiovascular events (CVE) during childbirth in multiple versus singleton gestations and evaluated if the observed association was independent of hypertensive disorders of pregnancy (HDP).
Study Design:
In a secondary analysis of women in the Consortium on Safe Labor, maternal demographics, number of fetuses, HDP diagnosis, gestational age, and CVE during childbirth were collected from medical records and ICD9 codes. Multiple imputation addressed missing covariate data. Relative risks (RR, 95% CI) of CVE for twin and triplet compared to singleton pregnancies were calculated using modified Poisson regression with robust standard error adjusted for maternal age, pre-pregnancy body mass index, race/ethnicity, parity, insurance status, marital status, site, chronic disease, and stratified by HDP status.
Results:
Of the 191,948 deliveries, 2.2% were twin and 0.1% were triplet deliveries. CVE occurred in 0.4% of singletons, 1.0% of twins, and 2.0% of triplets (P < 0.001, Table). There was an elevated risk of CVE in twin and triplet gestations compared to singletons [Twins: 2.79 (2.05-3.81); Triplets: 4.90 (1.59-15.07), Figure]. Twin gestations remained at an elevated risk of CVE [2.35 (1.72-3.21)] after accounting for baseline differences and in subgroup analyses by HDP status [Twins vs Singletons: HDP: 2.75 (1.73-4.37); Without HDP: 1.69 (1.08-2.63), Figure]. Notably, triplet gestations had higher risk of CVE among women without HDP than those with HDP [Triplets vs Singletons: HDP: 3.17 (0.80-12.60); Without HDP: 2.21 (0.28-17.48), Figure].
Conclusion:
Multiple gestation was an independent risk factor for CVE during childbirth. Given that CVE is a major risk factor for severe maternal morbidity, our findings highlight the importance of risk stratification and heightened awareness in patients with multigestation pregnancies.